The Ministry of Health and Social Services (MoHSS) on Tuesday, 13 September, launched a study report on Equity in Health Care in Namibia, which is aimed at generating evidence needed to enhance the health ministry’ endeavors to redressing inequities in resource allocation in the country. The study specifically purports to develop a needs-based allocation formula that will assist the MoHSS to shift its resource allocation mechanism away from the historical incrementalist type.
Equity in Health
Equity as a shared vision for health and development
Editorial: The Lancet 376(9745): 929, 18 September 2010
According to the September editorial of The Lancet, overall, progress on achieving the Millennium Development Goals(MDGs) is uneven, with some regions, especially in the poorer countries, lagging far behind. The editors argue that business cannot continue as usual in the next five years if the promises made a decade ago are to be met. On the positive side, the MDGs have achieved much. They have mobilised unprecedented political support, advocacy efforts, financial resources, and have encouraged improved monitoring and evaluation of programmes. However, the editors argue that the targets were narrow and fragmented. Potential links and synergies between goals have not been fully realised. Over the past 40 years improvements in women's education (MDG 2) has reduced child mortality (MDG 4) substantially, averting 4.2 million deaths globally. Furthermore, the results point to the importance of a reduction of the gender gap in educational achievement, thereby promoting gender equity and empowering women (MDG 3). The addition of new targets over time has also been unsuccessful, as seen with universal access to reproductive health. Newer priorities facing the world, such as non-communicable diseases (NCDs) and climate change, have been slow to be accepted in the current framework, although the focus on NCDs at the UN General Assembly in September, 2011 may be an important step forward. Given these problems and challenges, the editorial proposes that the next MDG framework be built on a shared vision of development across the life course rather than on separate goals and targets. It argues that the issue of equity should be central to any measures, focusing on those who are marginalised.
Equity enhances the power of growth to reduce poverty: World Development Report 2006
Equity, defined primarily as equality of opportunities among people, should be an integral part of a successful poverty reduction strategy anywhere in the developing world, says the World Bank's annual 2006 World Development Report. Equity and Development, produced by an eight-member team of authors led by economists Francisco Ferreira and Michael Walton, makes the case for equity, not just as an end in itself, but because it often stimulates greater and more productive investment, which leads to faster growth. The report shows how wide gulfs of inequality in wealth and opportunity, both within and among nations, contribute to the persistence of extreme deprivation, often for a large proportion of the population. This wastes human potential and, in many cases, can slow the pace of sustained economic growth. More information on the report is available at: http://econ.worldbank.org/wdr/wdr2006/
Further details: /newsletter/id/31288
Equity in access to health: Dream or reality?
Hery-Jaona J: Geneva Health Forum, 31 August 2006
This session of the August 2006 Geneva Forum on health explored equity in health, including equity of access to essential drugs. Speakers identified constraints to equity, and suggested that equitable access to health care can only be achieved through reformation of the health sector. Measures proposed included a focus on poor geographic areas; the indirect measurement of the recipient's economic status; payments to poor service recipients; mass campaigns; contracting with NGOs and the active involvement of the poor. Inequity is not only due to social determinants and also demands scaling up financing of health systems.
Equity in access: Interview with Eritrean Health Minister
Krebs V: Geneva Health Forum, 2 September 2006
Hon Minister Salih Meky, Minister of Health of Eritrea, spoke with interviewers at the August 2006 Geneva Forum for Health about achievements and challenges in the field of health in Eritrea and in Africa more generally. In Eritrea, health care is free of charge at point of care. The country has managed to keep under control a number of infectious diseases, but faces the increasing challenge of chronic illnesses, such as diabetes, hypertension and cancer. Hospital costs are a major issue. Minister Meky questioned whether there was a simple solution to the brain drain, and urged that it be addressed by the South and by the wealthy countries in the North. He observed that one priority was to improve living conditions and opportunities in the south and another for developed countries to help to train people. He felt that while there ought to be free movement of people, the brain-drain must be solved.
Equity in health and health care in Malawi: analysis and trends
Zere E, Moeti M, Jirigia J: BMC Public Health, 2007
This article in BMC public health assesses trends in inequities in health and health service utilisation in Malawi using data from the Demographic and Health Surveys (DHS) of 1992, 2000, and 2004. The paper finds that there has been an increase in the levels of pro-rich inequity in infant and under-five mortality rates. This implies that the burden of infant and under-five mortality is getting disproportionately higher among children from the poor than the non-poor households. Inequalities are also observed in the use of interventions including treatment of diarrhoea. In addition, the paper finds that the publicly provided services for some of the selected interventions including child delivery, benefit the non-poor more than the poor.
Equity in health and healthcare in Malawi: analysis of trends
Zere E, Moeti M, Kirigia J, Mwase T, Kataika E: BMC Public Health 7:78, 15 May 2007
Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.
Equity in health and healthcare in Malawi: Analysis of trends
Zere E, Moeti M, Kirigia J, et al: BMC Public Health; 7,78, 2007
Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/ healthcare are not properly addressed. This study attempts to assess trends in inequities in selected indicators of health status and health service utilisation in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004. The widening trend in inequities, in particular healthcare utilisation for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.
Equity in Maternal Health in South Africa: Analysis of Health Service Access and Health Status in a National Household Survey
Wabiri N; Chersich M; Zuma K; Blaauw D; Goudge J; Dwane N: PLoS One 8(9), 2013
South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources. This analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile. Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.
Equity in Maternal Health in South Africa: Analysis of Health Service Access and Health Status in a National Household Survey
Wabiri N, Chersich M, Zuma K, Blaauw D, Goudge J, Dwane N: PLoS ONE 8(9): e73864. doi:10.1371/journal.pone.0073864 September 2013
South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources.
This analysis drew on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. The survey found that the poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2–6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.